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V. Balestra
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P2.04 - Poster Session with Presenters Present (ID 466)
- Event: WCLC 2016
- Type: Poster Presenters Present
- Track: Mesothelioma/Thymic Malignancies/Esophageal Cancer/Other Thoracic Malignancies
- Presentations: 1
- Moderators:
- Coordinates: 12/06/2016, 14:30 - 15:45, Hall B (Poster Area)
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P2.04-036 - Giant Primary Dedifferentiated Liposarcoma of the Anterior Mediastinum: An Extremely Rare Occurrence (ID 4031)
14:30 - 14:30 | Author(s): V. Balestra
- Abstract
Background:
To present an extremely rare case of giant primary dedifferentiated liposarcoma of the anterior mediastinum.
Methods:
A 70-year-old male presented for persistent dyspnoea. Chest CT-scan showed a huge well-defined solid mass with a fatty tissue component in the anterosuperior mediastinum (Fig.1A). The tumour caused a wide displacement of the right lung and mediastinal organs with no signs of invasion. PET-CT scan showed a unique uptake of the mediastinal mass (Suv max=4.6). A surgical resection was proposed. A right emiclamshell incision was performed. On exploration, a huge mass of the anterior mediastinum causing the compression of the right lung, pericardium and great vessels was observed; no sign of adjacent organs invasion was found. The tumour was radically resected and the patient was discharged uneventfully after 6 days. The patient denied any adjuvant therapy. No evidence of recurrence has been identified as of 16 months postoperatively.
Results:
Macroscopically, the smooth, lobulated, well demarcated, yellowish-white mass weighed 2102g and measured 27x23x13cm (Fig.1B). Microscopically, the tumour presented a dedifferentiated component characterized by spindle cells organized in a fascicular pattern with abundant stroma and necrosis (Fig.1C) and a second component of lipoma-like well-differentiated liposarcoma (Fig.1D). Figure 1E showed both components. The spindle cells displayed a moderate degree of nuclear atypia, with moderate to marked levels of pleomorphism and cellularity. The spindle cells resulted positive for desmin and SMA and had an elevated proliferative index (Ki67=50%) (Fig.1F). Immunohistochemically, tumour cells of both components were positive for CDK4 (Fig.1G) MDM2 (Fig.1H) and negative for myoglobin, EMA, S-100. Given that, a final pathological diagnosis of primary dedifferentiated liposarcoma of the mediastinum was disclosed. Figure 1
Conclusion:
Primary dedifferentiated liposarcoma of the mediastinum is extremely rare. Chemotherapy and radiotherapy seems to be ineffective; radical surgical resection represents the best therapeutic modality. A closed and long-term follow-up is required because of the high risk of recurrence.
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P3.01 - Poster Session with Presenters Present (ID 469)
- Event: WCLC 2016
- Type: Poster Presenters Present
- Track: Biology/Pathology
- Presentations: 1
- Moderators:
- Coordinates: 12/07/2016, 14:30 - 15:45, Hall B (Poster Area)
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P3.01-004 - Exceptional Evolution of Benign Metastasizing Leiomyomas of the Lung (ID 4028)
14:30 - 14:30 | Author(s): V. Balestra
- Abstract
Background:
to describe an exceptional case of malignant transformation of benign metastasizing leiomyomas (BML) of the lung.
Methods:
a 62-year-old woman presented for radiological finding of multiple bilateral pulmonary nodules. Nine years before, she underwent hysterectomy for uterine leiomyoma. After pulmonary biopsy, a diagnosis of BML was made. Subsequently, a surgical resection of the right pulmonary nodules was performed; histopathological examinations confirmed the diagnosis of BML (Ki67=1%; strong expression of estrogen and progesterone receptor as depicted in Fig.1C-E). The patient was put on anastrazole therapy but an increase of the left pulmonary nodules was observed. Therefore, a surgical resection of the left nodules was carried out; final pathological examination confirmed BML. Three years later, a chest CT-scan showed bilateral pulmonary relapses; tamoxifen was started but it was ineffective. Then, a surgical resection of the right pulmonary nodules was performed (Fig.1A-B). The patient was discharged uneventfully on postoperative day 5.
Results:
macroscopically, the nodules had whitish and yellowish colour, smooth margins, with tense-elastic consistency. Microscopically, an intersecting bundles of spindle cells with moderate nuclear atypia organized in a fascicular pattern were clearly evident (Fig.1F). The mitotic activity was more pronounced than previous histological samples (up to 10 mitoses/10HPF). Immunohistochemical studies showed positivity for smooth-muscle actin, desmin, and negativity for HMB-45, CD34, and TTF-1; Ki-67=20% (Fig.1G). Estrogen and progesterone receptor were weakly positive (Fig.1H). Based on the current criteria, a diagnosis of low-grade leiomyosarcoma was made. The patient denied the contralateral surgical resection. Eighteen months later the chest CT-scan revealed bilateral pulmonary nodules; she is currently under megesterol acetate treatment. Figure 1
Conclusion:
BML of the lung is a rare pathological condition with a usually indolent clinical course. Although it’s exceptional, an evolution towards a low grade leiomyosarcoma should be considered in the natural history of the disease.
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P3.03 - Poster Session with Presenters Present (ID 473)
- Event: WCLC 2016
- Type: Poster Presenters Present
- Track: Mesothelioma/Thymic Malignancies/Esophageal Cancer/Other Thoracic Malignancies
- Presentations: 1
- Moderators:
- Coordinates: 12/07/2016, 14:30 - 15:45, Hall B (Poster Area)
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P3.03-012 - Tumor-Infiltrating Lymphocytes, PDL-1, BAP-1, VEGFR-2 and IGF-1R Expression in Malignant Pleural Mesothelioma (ID 4142)
14:30 - 14:30 | Author(s): V. Balestra
- Abstract
Background:
to investigate whether there was any relationship between survival and the expression of tumor infiltrating lymphocytes (TILs), programmed cell-death-ligand-1 (PDL-1), BAP-1 (BRCA1-Associated Protein 1), VEGFR-2 (vascular endothelial growth factor receptor 2) and IGF-1R (Insulin-Like Growth Factor 1 Receptor) in malignant pleural mesothelioma (MPM).
Methods:
63 cases of MPM were identified. All tissues were obtained at the time of diagnosis. There were 40 males; mean age was 70.4 years. 34 patients were smokers and 40 had a certain history of asbestos exposure. All histological slides were revised; there were 30 epithelioid subtypes, 20 biphasics and 13 sarcomatoids. The presence of TILs was scored as absent, weak, moderate and strong according to a quantitative assessment on hematoxylin and eosin slides. The expression of BAP-1, VEGFR-2, PDL-1 and IGF-1R was analyzed by immunohistochemistry. The impact of asbestos exposure, tobacco consumption and histological subtypes on survival were also assessed. The survival analysis was analyzed by Kaplan Meier curve.
Results:
TILs were present in 89% of cases and were found to be a favorable prognostic factor (p=0.009) although related with histological subtypes (p=0.008). The absence of TILs was higher in biphasic and sarcomatoid subtypes (90.9%, 30/33) compared to epithelioid MPM (53.3%, 16/30 p<0.001). Median survival in TILs and non-TILs patients was 28 months and 11 months, respectively. The expression of PDL-1 in tumor cells (cut-off: 10%, p=0.028) and VEGFR-2 in TILs (p=0.003) were related with survival, but they were differently expressed in histological subtypes. Using a logistic regression model, TILs, PDL-1 and VEGFR-2 in TILs correctly classified 21/30 epithelioid subtypes (70%) and 29/33 biphasic and sarcomatoid subtypes (87.9%). IGF-1R was overexpressed in 82% of the tumors (21 epitheliods and 31 sarcomatoids) and in 25% of TILs (7 epitheliods and 3 sarcomatoids) and was a favorable prognostic factor (p=0.023) independently of the histological subtype. Median survival was 4 and 13 months in patients not overexpressing and overexpressing IGF-1R, respectively. In a Cox regression model including both IGF-1R and histological subtype, IGF-1R remained significant [p=0.006, HR=0.41 (0.20-0.84)]. Tobacco, asbestos exposure, age and BAP-1 expression were not significantly related with survival.
Conclusion:
the histological subtype is an important prognostic factor in MPM and it’s related to different histological markers: the presence of TILs, PDL-1 and VEGFR-2 in TILs. Moreover, the overexpression of IGF-1R is an independent favorable prognostic factor. Therefore, histological markers may improve the prognostic assessment of MPM and provide mechanistic clues for new therapeutic strategies.
